School health services offered as part of primary health care in Libya was ... methodologies in the domain of Public Health within the Libyan context will enable.
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2& )*3/ +) 456%77888& % ) 9 : * & / - ;5=40 NA Sex Male Female NA Educational level Primary Secondary Higher NA Nationality Libyan Others NA Marital status Married Divorced Widower Single NA Total
Parent Teacher Health Team Number Percent Number Percent Number Percent 5 6 20 86 345 23
1.0 1.1 4.1 17.6 71.6 4.6
1 13 49 21 69 47
0.5 6.5 24.5 10.5 34.5 23.5
2 6 6 7 1
9.1 27.3 27.3 31.8 4.5
412 67 6
84.9 13.9 1.2
27 171 2
13.5 85.5 1.0
12 9 1
54.6 40.9 4.5
78 203 179 25
16.1 41.8 36.9 5.2
91 64 45
45.5 32.0 22.5
17 5 -
77.3 22.7 -
459 9 17
94.6 1.9 3.5
189 2 9
94.5 1.0 4.5
22 100.0 -
451 6 12 11 5 485
93 1.2 2.5 2.3 1 100.0
127 63.5 6 3.0 4 2.0 59 29.5 4 2.0 200 100.0
20 90.9 2 9.1 22 100.0
117
A well maintained washroom
A well maintained toilet
b.
Perceived benefits Perceptions are important in any public health program in the sense that they leads to utilization and managerial efficiency. It is imperative that all the stakeholders in any specific public health program develop a positive perception and attitude, which contributes to overall efficiency. That is, parents, teachers and school health team members, all together, motivate positively to involve. Such a positive involvement serves program beneficiaries. An essential precondition for such a concerted effort from the part of participants is a positive thinking and perceived advantages/benefits.
View of a class room
A well maintained washroom
Table 3 shows that the stakeholders, especially teachers were less confident of the program benefits to students. Nearly half of the teachers perceived that the program was not at all beneficial to students. But it is to be noted that more than one-fourth of parents perceived services as beneficial to students. Services to children benefit parents in three ways; (i) by easing care (ii) bringing up children healthy and (iii) providing education on child care and child health problems. Teachers, who dealt with students directly and who realize their potential and intellectual development are expected to be benefited by the care of the multidisciplinary team. Surprisingly, neither the parents nor the teachers perceive these advantages. On the contrary, the perceptions of teachers were depressingly just the opposite. Similar results were obtained about the program benefits from the non-teaching staff.
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Table 3 Perceived benefits of school health program Benefits/ Parents Teachers SHT members beneficiaries Number % Number % Number % Benefit to Students 9.1 2 3.0 6 7.8 38 Highly beneficial 4.5 1 8.5 17 138 28.5 Sufficiently beneficial 8 36.4 37 18.5 6.6 32 Average beneficial 9.0 2 20 10.0 83 17.1 Low beneficial 3 13.6 98 49.0 94 19.4 Not beneficial 6 27.3 22 11.0 100 20.6 NA Benefit to parents 4.5 1 3.0 6 89 18.4 Highly beneficial 9.1 2 5.0 10 5.4 26 Sufficiently beneficial 4 18.2 7.0 14 79 16.3 Average beneficial 9.1 2 8.5 17 6.0 29 Low beneficial 4 18.2 107 53.5 137 28.1 Not beneficial 9 40.9 46 23.0 125 25.8 NA Benefit to teachers 4.5 1 2.0 4 64 13.2 Highly beneficial 4.5 1 20 10.0 58 12.0 Sufficiently beneficial 8 36.4 22 11.0 85 17.5 Average beneficial 9.2 2 7.0 14 3.5 17 Low beneficial 3 13.6 116 58.0 95 19.6 Not beneficial 7 31.8 24 12.0 166 34.2 NA Benefit to non-teaching staff 4.5 1 2.5 5 65 13.4 Highly beneficial 9.1 2 8.5 17 55 11.3 Sufficiently beneficial 5 18.2 8.0 16 83 17.1 Average beneficial 9.1 2 8.0 16 4.3 21 Low beneficial 3 18.2 102 51.0 91 18.8 Not beneficial 9 40.9 44 22.0 170 35.1 NA Total 485 100.0 200 100.0 22 100.0
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There are indications that the programs administered by the team under the department of health have not yet succeeded in gaining confidence of its stakeholders. This low level of confidence influences program attitude of the stakeholders. This low esteem and image of programs as evident from the perception of their utility might influence program implementation and utilization. It calls upon the executives of school health programs to realize the importance of perceived benefits in order to work meticulously to create the desired image in the minds of stakeholders.
An old toilet
Dining space in a school
c.
Issues of Concern As far as health care programs are concerned, there are a number of concerns of priority to the stakeholders. It is important for the program planners and implementers to consider these priorities and preferences. There might be a number of services that one may well consider important to the school child. But when a service provider offer limited services that are considered to be of importance to the beneficiaries, services are being elevated to the confidence of beneficiaries. In that sense, the service components of importance to school children as perceived by its stakeholders, namely the teachers and school health team members, are periodic medical checkups (10), environmental hygiene programs, health education for all partners of the program - children, parents and teachers. Facilities and services for first aid have also been considered to be of importance as part of school health services. Periodic medical checkups serve the purpose of identification of infections, health risks and malnutrition. Environmental hygiene serves the purpose of prevention of spread of infection, vector and rodent control and building healthy life style devoid of diseases and disabilities. Educating children and parents on balanced diet helps in promoting nutritional status (3, 11).
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Table 4 Issues of concern to school Health services Issues of concern Teachers School health teams Number Percent Number Percent Medical checkup 97 48.5 6 27.3 Environmental hygiene 11 5.5 5 22.7 Health Education 4 2.0 7 31.8 First Aid 3 1.5 NA 85 42.5 4 18.2 Total 200 100.0 22 100.0 It is urged to the program planners and policy makers to reconsider and rebuild the program with periodic screening and medical checkups, assessment and monitoring of environmental condition including surroundings, canteens, bathrooms and class rooms. Health education sessions for students, teachers and parents in formal and informal sessions should be organized as part of school health activities (3).
Food packing place
A store
d. Knowledge of Stakeholders Regarding Services It is important, at least, for the stakeholders to have an understanding about various services that are part of school health activities. It is mandatory for the program implementers to spread information and build knowledge among beneficiaries for improving accessibility. It is important for the program to be heard and known to the beneficiary. It is also important for the program executing body to meet parents of students and discuss issues, which might enhance confidence and thereby, participation in the program.
121
An unhygienic store
Shabby washroom
It is imperative that for a program to be successful and widely accepted, in addition to the provision of service and the knowledge about these services be shared. As far as the parents are considered, they knew about immunization services rendered by school health teams but their knowledge on first aid services were limited to nearly three-fifths of parents. Additionally a large majority opined that these services are not integrated to the school activities; referring to the need for improving the system of first aid offered through school health programs.
A store room
Shabby toilet
The opinion of teachers and school health team members regarding type of vaccinations is a bit incredulous. Only a portion of the teachers and school health team members reported about their knowledge of vaccinations, which is unbelievable and requires further examination.
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Knowledge Availability of immunization Yes No No Data Total Type of vaccines given Polio vaccine DT vaccine Meningococcal and meningitis Hepatitis vaccine All vaccines NA Total Availability of first aid Yes as an integral part Yes not as an integral part Yes not of use Not at all NA Total
Table 5 knowledge about school health services
438 34 13 485
67 146 47 204 21 485
90.3 7.0 2.7 100.0
13.8 30.8 9.7 42.1 4.3 100.0
12 58 33 84 13 200
10 3 4 42 42 4 105
6.0 29.0 16.5 42.0 6.5 100.0
5.0 1.5 2.0 21.0 2.0 68.5 100.0
2 5 8 7 22
21 1 22
9.1 22.7 36.4 31.8 100.0
95.5 4.5 100.0
Parent Teachers SHT members Number Percent Number Percent Number Percent
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e.
Hygienic condition One of the major tasks of school authorities in association with parents and school health team is to look into the aspect of hygiene inside the school including the class rooms, corridors, canteen, wash rooms and bath rooms. Maintenance of hygiene in school was explored from the opinions of parents and school health team members. Nearly one of parents opined that there was reasonable hygiene in the school whereas more than one quarter of parents stated that hygienic condition is good in schools. Table 6 Hygienic condition in the school Hygienic condition Number Percent Parents rating of hygienic condition 8.7 42 Very good 27.4 133 Good 31.8 154 Reasonable 14.2 69 Bad 11.3 55 Very bad 6.6 32 NA 100.0 485 Total Frequency of examination by SHT 18.2 4 Once in 3 months 9.1 2 Once in 6 months 63.6 14 Once in an year 9.1 2 NA 100.0 22 Total There were differential opinions among school health team members that examination on hygiene is made once in a year. Some members stated that examinations are made every 3 months, which is contradicting the majority opinion.
An old washing space
Poor hygiene
It is inevitable, at this moment, to look into the hygienic situation of schools and implement measures to maintain cleanliness in order to bring up the children happy and healthy. School health programs have a herculean task in this respect. 124
Conclusions The present study has brought points of importance regarding school health program and services. The school health services program in Benghazi city was not integrated with the other elements of primary health care. It has neither introduced all the requisitioned services nor have they undertaken frequent visits to the school community. Health education programs in Benghazi conducted as a part of the school health programs were not highly beneficial and were conducted only on demand, which arises very rarely. Environmental health issues were the least attended. First aid services were not available in a majority of schools. Most school meets infrastructure standards but not environmental hygiene standards. The participation of stakeholders (parents, teachers and team members) is an issue of concern in bringing school health programs to the forefront of primary health care programs, for which Benghazi school health team has miles to go. Recommendations x Increase school health team’s frequency of visit to school to at least 3 times a year. x
Emphasize monitoring and evaluation of school health programs.
x
Improve involvement of parents, teachers and community leaders in the program and create coalitions.
x Promote service provisions of school health programs. References 1. Allensworth DD, Kolbe LJ. The comprehensive school health program: exploring an expanded concept. Journal of School Health 1987;57(10): (409– 12). 2. CAHPERD. Quality School Health Ottawa. Canadian association for health physical education recreation and dance (http;\\ www.cabperd.ca), Accessed on 2006. 3. Kreuter, M.W. Christenson, G.M. and Davis, R, School health education research: future issues and challenges, Journal of School Health 1984, 54, 6,( 27-32). 4. ﻣﺴﯿﺤﻰ ( ﺑﺸﺄن2007 ) ر. و1375 ( ﻟﺴﻨﺔ49) ﻗﺮار أﻣﯿﻦ اﻟﺠﻨﺔ اﻟﺸﻌﺒﯿﺔ اﻟﻌﺎﻣﺔ ﻟﻠﺼﺤﺔ واﻟﺒﯿﺌﺔ رﻗﻢ اﻟﺘﻨﻈﯿﻢ اﻟﺪاﺧﻠﻰ ﻟﻠﺠﺎن اﻟﺸﻌﺒﯿﺔ ﻟﻠﺼﺤﺔ واﻟﺒﯿﺌﺔ ﺑﺎﻟﺸﻌﺒﯿﺎت
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5. 6. 7. 8.
9.
10.
–. دراﺳﺔ ﺣﻮل ﺗﻄﺒﯿﻖ ﺑﺮاﻣﺞ اﻟﺼﺤﺔ اﻟﻤﺪرﺳﯿﺔ, ﺳﻤﯿﻮ ﻣﺤﻤﺪ ﻧﺠﯿﺐ ﻣﺤﻤﺪ، – اﻟﻜﻮﺷﻰ ﺳﺎﻟﻢ اﺑﺮاھﯿﻢ .(2004) ﻛﻠﯿﺔ اﻟﻄﺐ –ﺟﺎﻣﻌﺔ اﻟﻔﺎﺗﺢ ﻗﺴﻢ ﺻﺤﺔ اﻟﻤﺠﺘﻤﻊ Florida School Health Program www.floridahealth.com. Accessed on April 20, 2008. Hobson, P., 1979, Health of the school child in The Theory and Practice of Public Health, New York, Oxford University Press(529-540) . Elfituri, A.A., Elmashaishi, M.S. and MacDonald, T.H, Role of health education programs within the Libyan community, Eastern Mediterranean Health Journal, ., 1999 5: 2( 268-276). Salam, M.A., Ali, S. and Mohammed, N., Quality of School Health Programs from the Perspectives of Providers and Beneficiaries, Project Report submitted to Faculty of Public Health, Benghazi, Al Arab Medical University, 2008. Park, K, Parks textbook of preventive and social medicine, Jabalpur, M/s. Banarsidas Bhanot Publishers, 2001.
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Health Seeking Behavior of Adolescents and Youths (University Students) in Benghazi Asharaf Abdul Salam, Hajer Abd AlLatif Mohammed, Nisreen Mobark AlAbar Abstract Behaviors vary across population groups. Healthy habits that develop during the period last for long and which offer hope for reduction of health needs of future generations. It is therefore very important to develop health seeking behaviors among the adolescent group. The current study was conducted to understand the health seeking behavior of adolescents and youths. This cross sectional study conducted in Benghazi city, took a representative sample from two premier universities that covers 38 percent of Benghazi population between the ages 17-24 years. Adopting a stratified sampling technique, a total of 383 students were covered, giving proportional representation to sex and faculty of education. Tools were developed for a face to face interview. Results reveal that subjects seek health care with their own preferences of initial consultations based on intimacy, professionalism and specialized knowledge from both physicians and specialists from allied medical fields. A large gap was identified between realization and consultations as well as between consultations and hospitalizations. Introduction Adolescents and youths offer great hope for reduction of health needs in the future. This stage of human life is characterized by growth, health and ability development. Health interventions on this age group focus on influencing and molding attitudes and behaviors. By attending to causes of future morbidity by aiming to reach maximum preventable risk due to smoking, drug use, diet, physical activities and health interventions, situations and factors leading to psychiatric morbidity can be reduced (1). Endeavors focusing on adolescents to promote their health through various strategies recognize the importance of culture and tradition for future health and development of countries (2). Adolescence defined as an age between 10 and 19 years (3) has a serious importance in reproductive health planning and development programs, Tobacco Free Initiative and the HIV/AIDS program. The Forty Second World Health Assembly has recognized the importance of youth as a critical element for the health of future generations and the profound impact of their health actions, 127
choices and behaviors (4). Adolescence and youth are overlapping stages of human development, youth being between the ages between 15 and 24 years (3). Therefore both these groups have health service programs of similar nature (2). Major transitions namely habit formation, patterns of behavior and relationships that develop during adolescence affect not only the functioning and opportunities of their adult lives but also its quality (5,6). This "transitional" period is an interim stage of "no fixed identity", where persons move from a stage of epitome of irresponsibility to a stage of personification of responsibility (7); thus termed as a stage of "Identity vs. Role Confusion". The Population Council makes attempts to pave a smooth transition to adulthood through strengthening social and health services to meet adolescent girls health and development needs by aiming at (i) testing feasibility of using community resource people to provide reproductive health information to adolescent girls (ii) defining appropriate venues, including the possibility of creating special spaces, for married and unmarried adolescent girls (iii) determining appropriate content of training (e.g., skill building, savings clubs, reproductive health information) and (iv) developing appropriate indicators for evaluating and measuring project outcomes (8,9). Healthy and happy adolescents, the gateway and youths, the pathway are better equipped to contribute to their communities (10). Objectives The current study was carried out with the aim of understanding the health seeking behavior of adolescents and youths. The specific objectives of the study are (i) to explore the reasons for preferring persons for consultations and (ii) to understand the gaps in realization of the problem and consultations with physicians and (iii) to explore the gap between consultations and hospitalizations. Methodology This cross sectional study was conducted in Benghazi City, Libya by taking a sample of students from two universities - Al Arab Medical and Garyounis (currently a single university), through a survey conducted during January-February 2010. Sampling Technique Assuming that age distribution of Benghazi population follows the trend similar to that of Libya i.e., 16.5 percent are aged 17-24 years; Benghazi has a total of 111,367 persons in the age range (Total population of Benghazi is 674,951 as per the 128
2006 census) (11). It is this group of population that is considered as adolescents and youths. Nearly half of the population of Benghazi, aged 17-24 years, is students of these two universities, the remaining being in the final year of school, in various occupations or searching avocations or idling around. Applying the sample size calculation for a margin of error acceptable as 5% and a confidence level needed as 95%, the minimum required sample size was 383 (12). Garyounis and Al Arab Medical Universities had a total student strength of 42,688, which can be stratified according to sex and faculty of enrollment (Table 1). Table 1 Sampling plan with proportional representation by sex and faculty Faculty Total students Sample Male Female Total Male Female Total 1299 3199 4494 12 29 Medicine 40 377 1419 1796 3 13 16 Dental 385 1259 1644 3 12 15 Pharmacy 224 911 1135 2 8 10 Public Health 162 171 333 1 2 3 Nursing 3334 1230 4564 30 11 41 Engineering 2201 4766 6967 20 43 63 Science 5893 3989 9882 53 36 89 Economics 1634 4969 6603 15 44 59 Arts 139 1848 1987 1 17 18 Education 790 1642 2432 7 15 22 Law 490 361 851 4 4 8 Computer Science 16928 25764 42688 152 231 383 Total Source: Director of Academic Administration, Al Arab Medical University; Director of Academic Administration, Garyounis University Sample elements were selected through a random skipping method through a random start and sampling interval method using random number tables and blindly selecting the starting point at the table. Respondents were selected from the campus (outside the classrooms), during working days. Data collection was carried out, privately, after ensuring confidentiality of information. Since the Health Status index and Emotional Scale were more personalized tools; they were supplied as selfadministered questionnaires. Information on health status, health seeking behavior and socio-economic background were collected through face to face interviews. Data processing and analysis Survey monitoring and data quality assurance process was progressed through scrutinizing, field editing and centralized editing (13). Following the manual of 129
Emotional Scale, a scoring system was prepared (14). An emotional score was calculated by adding the scores of all the 26 items, both emotional functions and emotional cognitive functions. Analyses were carried out through frequencies and cross tabulations. Mean values were calculated with major socio-economic background variables. Further chi square test and t-test (independent sample) were carried out to estimate significance of results. Results and Discussions Health seeking behavior of the sample population was explored by recollecting the last illness episode. Only 70.0 percent could recollect their last episode. The remaining failed to report. It was found that more males (71.5%) than females (69.0%) recollected the episode. There were differences in illnesses between males and females. Flu was found to be a major disease among males (32.7%), which was followed by accidents (9.1%) and digestive problems (5.5%). A large majority of females had digestive problems (12.0%) followed by flu (10.1%), sensory problems (6.3%) and depression (4.6%). Non communicable Diseases (NCDs) and accidents (3.8% each) created greater trouble for females. Males were comparatively less troubled by NCDs (0.9%). Among the subjects who could recollect their last illness episode, the people whom they consulted varied from parents to friends, doctors and others. More than half of the males (56.4%) and females (58.2%) consulted their parents first. Doctors were preferred for consultations more than friends by both males and females. Consultations were important leads in realizing health impact of a problem, a large majority recognized by self (before consultations – 56.3%); more by females (58.9%) as against males (52.7%). Consultations with doctors were perceived to be more useful than that with friends, in case of both males and females. There was a gap between feeling a health problem and actually realizing it. It was one week or less in a majority of cases (77.6%); the remaining cases taking up to one month or more. Such a delay in problem realization was found to be higher among females.
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Table 2 Health complaints experienced last Characteristics Male Female Total Reported Last Episode of Illness 60 (26.2) 106 (27.7) During Last Month 46 (29.9) 98 (42.8) 162 (42.3) 64 (41.6) During Last year 71 (31.0) 115 (30.0) 44 (28.6) Not reported 154 (100.0) 229 (100.0) 383 (100.0) Total Type of Illnesses 52 (19.4) 16 (10.1) 36 (32.7) Flu/Influenza 25 (9.4) 19 (12.0) 6 (5.5) Digestive Problems 16 (6.0) 6 (3.8) 10 (9.1) Accidents 12 (4.5) 10 (6.3) 2 (1.8) Sensory Problems 8 (3.0) 5 (3.1) 3 (2.7) Urinary Complaints 8 (3.0) 7 (4.6) 1 (0.9) Emotional disturbances 7 (2.6) 6 (3.8) 1 (0.9) NCDs 4 (1.5) 1 (0.6) 3 (2.7) Respiratory Diseases 1 (0.4) 1 (0.6) Migraine 1 (0.4) 1 (0.9) Epilepsy 1 (0.4) 1 (0.9) Love failures 91 (57.6) 138 (51.5) 47 (42.7) No answer First Person Consulted 92 (58.2) 154 (57.5) 62 (56.4) Parent 37 (13.8) 22 (13.9) 15 (13.6) Friend 62 (23.1) 37 (23.4) 25 (22.7) Doctors 15 (5.6) 7 (4.4) 8 (7.3) Others Time of realizing the problem 93 (58.9) 151 (56.3) 58 (52.7) Before consultations 33 (12.3) 13 (8.2) 20 (18.2) After consulting friend/relative 77 (28.7) 47 (29.7) 30 (27.3) After consulting doctor 1 (0.4) 1 (0.9) Others 6 (2.2) 5 (3.2) 1 (0.9) No answer Interval for problem realization (days) 87 (79.1) 121 (76.6) 208 (77.6)
